Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice

Subhash Edupuganti; Catherine Xie; Mary Wyrzykowski; Elizabeth Wey; Ming Xie

doi:doi:10.11648/j.ajcem.20170503.12

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Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice

Subhash Edupuganti, Catherine Xie, Mary Wyrzykowski, Elizabeth Wey, Ming Xie

Published in American Journal of Clinical and Experimental Medicine (Volume 5, Issue 3)

Received: 31 January 2017 Accepted: 14 February 2017 Published: 10 April 2017

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Abstract

Dabigatran, apixaban and rivaroxaban are direct oral anticoagulants (DOACs) recently approved for patients with venous thromboembolism. Therapy-induced hemorrhage remains a major complication in these patients. This study retrospectively reviews the hemorrhagic complications associated with DOACs in the general practice and the related clinical implications. The electronic medical charts of 2255 patients with prolonged PTT tests during August 2015 to April 2016 at William Beaumont Health System – Troy were retrospectively reviewed. Patients with prolonged PTT and simultaneously receiving DOAC’s were identified. Hemorrhagic complications associated with DOAC therapy and the related clinical information were analyzed. 517 (22.9%) patients were identified receiving DOAC therapy. Among these, DOAC therapy-associated hemorrhages were recorded in 85 patients (16.4%). Apixaban had a significantly lower incidence of hemorrhage (8.8%) than rivaroxaban (21.0%) and dabigatran (27.9%). The most common hemorrhage was GI bleeding (7.0% overall); its incidence was significantly higher in dabigatran (18.6%) than apixaban (4.1%) and rivaroxaban (7.4%); but no significant difference between apixaban and rivaroxaban (p>0.05). GI bleeding produced anemia in 13 patients who received additional treatments with occasional blood transfusions. Since GI bleeding is the most common bleeding complication and may cause anemia in patients receiving DOAC therapy, routine studies for GI bleeding should be encouraged to reduce the complications of GI bleeding. Apixaban has significantly lower incidence of bleeding complications, it may be a better choice in patients with increased bleeding risk overall. However, apixaban may not improve the bleeding risk in patients with GI bleeding associated with rivaroxaban.

Published in	American Journal of Clinical and Experimental Medicine (Volume 5, Issue 3)
DOI	10.11648/j.ajcem.20170503.12
Page(s)	64-68
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Anticoagulants, Gastrointestinal Hemorrhage, Activated Partial Thromboplastin Time, Apixaban, Rivaroxaban, Dabigatran

References

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[3]	Mantha S and Ansell J. Indirect comparison of dabigatran, rivaroxaban, apixaban and edoxaban for the treatment of acute venous thromboembolism. J Thromb Thrombolysis. 2015; 39 (2): 155-65.
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[6]	Gehrie E and Tormey C. Novel oral anticoagulants: efficacy, laboratory measurement, and approaches to emergent reversal. Arch Pathol Lab Med 2015; 139 (5): 687-692.
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[8]	Ufer M. Comparative efficacy and safety of the novel oral anticoagulants dabigatran, rivaroxaban, and apixaban in preclinical and clinical development. Thromb Haemost 2010; 103 (3): 572.
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[10]	Alotaibi G, Alsaleh K, Wu C, and Mcmurty MS. Dabigatran, rivaroxaban and apixaban for the extended venous thromboembolism treatment: network meta-analysis. Int Angiol, 2014; 33 (4): 301-8.
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[17]	Mary Wyrzykowski, Victoria Walley-Goike and Ming Xie. Retrospective analysis of abnormal partial thromboplastin time results in patients receiving new oral anticoagulants. Am J Clin Pathol 2016; 146 (suppl 1): 106 (abstract).
[18]	Halperin JL, Hankey GJ, Wojdyla DM, et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the rivaroxaban once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation (ROCKET AF). Circulation 2014; 130: 138-46.
[19]	McMahon BJ and Kwaan HC. The new or non–vitamin K antagonist oral anticoagulants: what have we learned since their debut. Semin Thromb Hemost 2015; 41 (2): 188–194.
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APA Style

Subhash Edupuganti, Catherine Xie, Mary Wyrzykowski, Elizabeth Wey, Ming Xie. (2017). Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice. American Journal of Clinical and Experimental Medicine, 5(3), 64-68. https://doi.org/10.11648/j.ajcem.20170503.12

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ACS Style

Subhash Edupuganti; Catherine Xie; Mary Wyrzykowski; Elizabeth Wey; Ming Xie. Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice. Am. J. Clin. Exp. Med. 2017, 5(3), 64-68. doi: 10.11648/j.ajcem.20170503.12

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AMA Style

Subhash Edupuganti, Catherine Xie, Mary Wyrzykowski, Elizabeth Wey, Ming Xie. Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice. Am J Clin Exp Med. 2017;5(3):64-68. doi: 10.11648/j.ajcem.20170503.12

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@article{10.11648/j.ajcem.20170503.12,
  author = {Subhash Edupuganti and Catherine Xie and Mary Wyrzykowski and Elizabeth Wey and Ming Xie},
  title = {Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice},
  journal = {American Journal of Clinical and Experimental Medicine},
  volume = {5},
  number = {3},
  pages = {64-68},
  doi = {10.11648/j.ajcem.20170503.12},
  url = {https://doi.org/10.11648/j.ajcem.20170503.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajcem.20170503.12},
  abstract = {Dabigatran, apixaban and rivaroxaban are direct oral anticoagulants (DOACs) recently approved for patients with venous thromboembolism. Therapy-induced hemorrhage remains a major complication in these patients. This study retrospectively reviews the hemorrhagic complications associated with DOACs in the general practice and the related clinical implications. The electronic medical charts of 2255 patients with prolonged PTT tests during August 2015 to April 2016 at William Beaumont Health System – Troy were retrospectively reviewed. Patients with prolonged PTT and simultaneously receiving DOAC’s were identified. Hemorrhagic complications associated with DOAC therapy and the related clinical information were analyzed. 517 (22.9%) patients were identified receiving DOAC therapy. Among these, DOAC therapy-associated hemorrhages were recorded in 85 patients (16.4%). Apixaban had a significantly lower incidence of hemorrhage (8.8%) than rivaroxaban (21.0%) and dabigatran (27.9%). The most common hemorrhage was GI bleeding (7.0% overall); its incidence was significantly higher in dabigatran (18.6%) than apixaban (4.1%) and rivaroxaban (7.4%); but no significant difference between apixaban and rivaroxaban (p>0.05). GI bleeding produced anemia in 13 patients who received additional treatments with occasional blood transfusions. Since GI bleeding is the most common bleeding complication and may cause anemia in patients receiving DOAC therapy, routine studies for GI bleeding should be encouraged to reduce the complications of GI bleeding. Apixaban has significantly lower incidence of bleeding complications, it may be a better choice in patients with increased bleeding risk overall. However, apixaban may not improve the bleeding risk in patients with GI bleeding associated with rivaroxaban.},
 year = {2017}
}

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TY - JOUR
T1 - Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice
AU - Subhash Edupuganti
AU - Catherine Xie
AU - Mary Wyrzykowski
AU - Elizabeth Wey
AU - Ming Xie
Y1 - 2017/04/10
PY - 2017
N1 - https://doi.org/10.11648/j.ajcem.20170503.12
DO - 10.11648/j.ajcem.20170503.12
T2 - American Journal of Clinical and Experimental Medicine
JF - American Journal of Clinical and Experimental Medicine
JO - American Journal of Clinical and Experimental Medicine
SP - 64
EP - 68
PB - Science Publishing Group
SN - 2330-8133
UR - https://doi.org/10.11648/j.ajcem.20170503.12
AB - Dabigatran, apixaban and rivaroxaban are direct oral anticoagulants (DOACs) recently approved for patients with venous thromboembolism. Therapy-induced hemorrhage remains a major complication in these patients. This study retrospectively reviews the hemorrhagic complications associated with DOACs in the general practice and the related clinical implications. The electronic medical charts of 2255 patients with prolonged PTT tests during August 2015 to April 2016 at William Beaumont Health System – Troy were retrospectively reviewed. Patients with prolonged PTT and simultaneously receiving DOAC’s were identified. Hemorrhagic complications associated with DOAC therapy and the related clinical information were analyzed. 517 (22.9%) patients were identified receiving DOAC therapy. Among these, DOAC therapy-associated hemorrhages were recorded in 85 patients (16.4%). Apixaban had a significantly lower incidence of hemorrhage (8.8%) than rivaroxaban (21.0%) and dabigatran (27.9%). The most common hemorrhage was GI bleeding (7.0% overall); its incidence was significantly higher in dabigatran (18.6%) than apixaban (4.1%) and rivaroxaban (7.4%); but no significant difference between apixaban and rivaroxaban (p>0.05). GI bleeding produced anemia in 13 patients who received additional treatments with occasional blood transfusions. Since GI bleeding is the most common bleeding complication and may cause anemia in patients receiving DOAC therapy, routine studies for GI bleeding should be encouraged to reduce the complications of GI bleeding. Apixaban has significantly lower incidence of bleeding complications, it may be a better choice in patients with increased bleeding risk overall. However, apixaban may not improve the bleeding risk in patients with GI bleeding associated with rivaroxaban.
VL - 5
IS - 3
ER -

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Author Information

Subhash Edupuganti

Department of Pathology, Oakland University School of Medicine, William Beaumont Hospital, Troy, Michigan, USA
Catherine Xie

Department of Pathology, Oakland University School of Medicine, William Beaumont Hospital, Troy, Michigan, USA
Mary Wyrzykowski

Department of Pathology, Oakland University School of Medicine, William Beaumont Hospital, Troy, Michigan, USA
Elizabeth Wey

Department of Pathology, Oakland University School of Medicine, William Beaumont Hospital, Troy, Michigan, USA
Ming Xie

Department of Pathology, Oakland University School of Medicine, William Beaumont Hospital, Troy, Michigan, USA

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Plain Text BibTeX RIS

APA Style

Subhash Edupuganti, Catherine Xie, Mary Wyrzykowski, Elizabeth Wey, Ming Xie. (2017). Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice. American Journal of Clinical and Experimental Medicine, 5(3), 64-68. https://doi.org/10.11648/j.ajcem.20170503.12

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ACS Style

Subhash Edupuganti; Catherine Xie; Mary Wyrzykowski; Elizabeth Wey; Ming Xie. Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice. Am. J. Clin. Exp. Med. 2017, 5(3), 64-68. doi: 10.11648/j.ajcem.20170503.12

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AMA Style

Subhash Edupuganti, Catherine Xie, Mary Wyrzykowski, Elizabeth Wey, Ming Xie. Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice. Am J Clin Exp Med. 2017;5(3):64-68. doi: 10.11648/j.ajcem.20170503.12

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@article{10.11648/j.ajcem.20170503.12,
  author = {Subhash Edupuganti and Catherine Xie and Mary Wyrzykowski and Elizabeth Wey and Ming Xie},
  title = {Bleeding Complications in Patients Receiving Direct Oral Anticoagulant Therapy in the Post Clinical Trial General Practice},
  journal = {American Journal of Clinical and Experimental Medicine},
  volume = {5},
  number = {3},
  pages = {64-68},
  doi = {10.11648/j.ajcem.20170503.12},
  url = {https://doi.org/10.11648/j.ajcem.20170503.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajcem.20170503.12},
  abstract = {Dabigatran, apixaban and rivaroxaban are direct oral anticoagulants (DOACs) recently approved for patients with venous thromboembolism. Therapy-induced hemorrhage remains a major complication in these patients. This study retrospectively reviews the hemorrhagic complications associated with DOACs in the general practice and the related clinical implications. The electronic medical charts of 2255 patients with prolonged PTT tests during August 2015 to April 2016 at William Beaumont Health System – Troy were retrospectively reviewed. Patients with prolonged PTT and simultaneously receiving DOAC’s were identified. Hemorrhagic complications associated with DOAC therapy and the related clinical information were analyzed. 517 (22.9%) patients were identified receiving DOAC therapy. Among these, DOAC therapy-associated hemorrhages were recorded in 85 patients (16.4%). Apixaban had a significantly lower incidence of hemorrhage (8.8%) than rivaroxaban (21.0%) and dabigatran (27.9%). The most common hemorrhage was GI bleeding (7.0% overall); its incidence was significantly higher in dabigatran (18.6%) than apixaban (4.1%) and rivaroxaban (7.4%); but no significant difference between apixaban and rivaroxaban (p>0.05). GI bleeding produced anemia in 13 patients who received additional treatments with occasional blood transfusions. Since GI bleeding is the most common bleeding complication and may cause anemia in patients receiving DOAC therapy, routine studies for GI bleeding should be encouraged to reduce the complications of GI bleeding. Apixaban has significantly lower incidence of bleeding complications, it may be a better choice in patients with increased bleeding risk overall. However, apixaban may not improve the bleeding risk in patients with GI bleeding associated with rivaroxaban.},
 year = {2017}
}

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